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Generally, yes. But some states require insurers to cover additional services and procedures. Even within the same state, there can be small differences.

When you compare plans in the Marketplace, you'll see the specific benefits each plan offers.

What if I need a specific treatment that's not on this list?

Plans may cover other services. When you compare plans, you’ll see more detailed information about what’s covered. If you want to find out if a particular service is covered, call the plan.

Do all types of Marketplace plans cover essential health benefits?

Yes. Any plan shown in the Marketplace includes these essential health benefits. This is true for all plan categories (all “metal levels,” including Catastrophic plans) and all plan types (like HMO and PPO).

Do I have to pay deductibles and copayments for essential health benefits?

Some preventive services are free, and some plans cover other services without out-of-pocket costs.

Do I get these benefits if my company is self-insured?

It depends. Large employers who "self-insure” — meaning they pay employees' health care costs directly — don't have to provide essential health benefits. But many do. Check with your employer to find out if it’s self-insured and what services are covered.

Are abortion services covered by Marketplace plans?

Sometimes, and plans may have different restrictions. Some offer no coverage or coverage with restrictions. In some cases abortion services cannot be paid for with federal dollars (these are known as “non-Hyde” abortion services).

Contact each plan to learn about its abortion coverage.

Do I get these benefits if I have a grandfathered plan?

It depends. Many grandfathered plans cover essential health benefits, but they’re not required to. To be sure, check with your employer or health plan.